Simultaneous Natural Conception in a Rudimentary Horn and ICSI Pregnancy in a Unicornuate Uterus Managed by Fetocide...

Simultaneous intrauterine and rudimentary horn pregnancies are exceedingly rare, particularly when one arises from assisted reproduction and the other naturally. Early diagnosis is essential to prevent life-threatening complications, such as rudimentary horn rupture. Careful ultrasound evaluation is critical to detect subtle congenital uterine anomalies that may otherwise go unrecognised.

A 39-year-old woman with primary infertility and multiple intramural fibroids conceived naturally and via intracytoplasmic sperm injection (ICSI). Her 43-year-old husband had oligo-astheno-teratozoospermia. After myomectomy and counselling, she underwent donor oocyte ICSI with her husband's sperm; the second cycle resulted in conception. Four weeks later, a transvaginal ultrasound confirmed a viable intrauterine pregnancy. At seven weeks, a second gestational sac was noted in the rudimentary horn. Three-dimensional ultrasound confirmed a unicornuate uterus with a non-communicating rudimentary horn unconnected to the cervical canal or main cavity. At 12 weeks, ultrasound-guided fetocide was performed using 0.2 mL of potassium chloride. The intrauterine pregnancy progressed uneventfully, culminating in a cesarean delivery at 34 weeks of a healthy female neonate weighing 2.3 kg. Both mother and infant remained well at the six-week follow-up.

This case illustrates the rare coexistence of a natural rudimentary horn pregnancy and an ICSI-conceived intrauterine pregnancy in a unicornuate uterus. It highlights the importance of detailed, high-resolution imaging, vigilant antenatal surveillance, and timely multidisciplinary management to ensure favourable maternal and fetal outcomes.